MEDICARE: DR. SWAPNA RAO LINGALA DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501013903	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RFH840847198	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1174026975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SWAPNA RAO LINGALA DPT

Provider Business Mailing Address
First Line	:	41643 STEINBECK GLN
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48377-2869
Country	:	US
Telephone Number	:	248-425-9715
Fax Number	:

Provider Business Practice Location Address
First Line	:	21450 ARCHWOOD CIR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336-4127
Country	:	US
Telephone Number	:	248-426-6910
Fax Number	:	248-888-8562

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2018
Last Update Date	:	03/17/2018

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